The 2004 GP contract is afflicting the NHS

WHAT neither Drs John Elliott nor Hamish Maclaren in their letters of January 9 and 10 mention as an important cause of the NHS meltdown – and is a good example of government mismanagement – is the new contract that was offered to general practitioners in 2004 by the Labour Government. This allowed GPs to opt-out of 24-hour responsibility for their patients. So, no more evening, night or weekend on-call that had been the backbone of the service. The great majority of GPs took this up at minimal financial cost to their incomes.

Unsurprisingly, attendances at accident & emergency departments increased, almost doubling in the subsequent decade, and they have continued to escalate. GPs and the British Medical Association will cry “foul” that the two events are causally related and will point to increasing age and patient demand as explanations. These are factors but neither age-demographics nor societal attitudes can have changed by nearly 100 per cent in one decade.

NHS 24 and similar phoneanswering services were introduced but could never effectively replace GPs. The resulting chaos at A&E is something the medical profession should take some responsibility for. It’s a major contributor to the NHS meltdown we’re witnessing.

Dr Stefan D Slater (retired consultant physician), 80 Whitehouse Road, Edinburgh.

AT the end of this month, the Scottish Government will close its consultation on its forthcoming Diet and Obesity Strategy. We hope by then it will have gathered a wealth of evidence to show that regulations to restrict multi-buy offers on unhealthy food and drink would be crucial in helping to stem the rising tide of obesity in Scotland.

There can be no doubt that a bold strategy is needed. Scotland has been in the grip of an obesity epidemic for too long.

Not only is Scotland one of the heaviest nations in Europe, but

Scots also buy double the amount of food and drink on price promotion than shoppers on the Continent. The Scottish Government’s commitment to limit junk food marketing is a step in the right direction but, to progress, regulations are needed to restrict multi-buy offers on unhealthy food and drink.

Obesity is linked to 13 different types of cancer. As part of its forthcoming obesity strategy, the Scottish Government must grasp the opportunity to help families make it easier to keep a healthy weight. Measures to help us enjoy a better diet and fill our shopping baskets with healthy food will make it easier for us all to stack the odds of not getting cancer in our favour. Professor Linda Bauld,

Cancer Research UK,

9-10 St Andrew Square, Edinburgh.

YOU report that there is a queue of nurses trained in Scotland waiting to take up suitable posts abroad (“Hundreds of Scottish-trained nurses planning to work abroad”, The Herald, January 5). This situation is intolerable.

In countries in the Americas, Asia, Australasia and Europe, healthcare professionals are treated with respect and are relatively well paid for what they do. By contrast, in the UK they are almost taken for granted, and only become the subject of attention when something goes wrong. I would suggest one possible solution is the setting up of an independent review body to examine terms and conditions within the NHS, bearing in mind the economic climate prevailing at the time. This entity should not just meet as a one-off, but be an on ongoing annual review body which makes recommendations, based on independent fact gathering, prior to negotiation between management and workforce taking place.

This would be beneficial not only to those engaged in the NHS but also to people like me who have a tendency to take for granted some of the benefits and good work offered by the NHS staff in Scotland.

Brian T McFarlane,

14 Balmoral Drive, Cambuslang.